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Editorial

Best possible outcome

Governor showed courage in tenacious push to expand Medicaid

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Thursday October 24, 2013 6:20 AM

On Monday, Gov. John Kasich got the right thing done for Ohio. With the approval of the
Controlling Board, his administration now is authorized to use federal funds to extend Medicaid
coverage to 275,000 poor Ohioans who are without health insurance.

House Speaker William G. Batchelder and Senate President Keith Faber also deserve credit, for
not torpedoing the Medicaid expansion even though both have spoken against it. Batchelder replaced
anti-expansion representatives on the Controlling Board with others known to support it.
Conversely, Faber left in place his two appointees, who also were known to support expansion.

What’s most remarkable about the lengths to which the governor was forced to go is that
expanding Medicaid coverage is popular among most Ohioans and every constituent group under the
sun: business, labor, hospitals, religious organizations and minority groups.

But a small number of right-wing ideologues oppose expanding Medicaid because the federal funds
for it come as part of President Barack Obama’s Affordable Care Act and because they oppose any
further federal deficit spending. This, despite the fact that as state lawmakers, their fiduciary
responsibility is to the state and its residents.

Their unthinking rejection would have hurt vulnerable Ohioans, turned aside potential savings of
state tax dollars and left hospitals on the hook for more uncompensated care.

About half of the 275,000 people are working, but have jobs with no benefits and incomes that
fall below the poverty line. More than 25,000 are veterans. Some are mentally ill and proper
medication could change their lives. Legislators — most of whom enjoy state-provided health
insurance, for which Ohio taxpayers pay more than 80 percent of the premium — would have denied
benefits to those thousands, even though the cost will be covered entirely with federal funds for
three years, and at least 90 percent after that.

Their objection also ignored the fact that people without health insurance don’t go entirely
without medical care; instead, when a health problem becomes a crisis, they go to emergency rooms
and receive care that’s more expensive, less effective and not subject to any controls.

This willingness to put ideology and politics ahead of the well-being of Ohioans, not to mention
common sense, is unconscionable.

Kasich didn’t make this move lightly. He turned to the Controlling Board only after exhausting
every other avenue to Medicaid expansion. He included it in his budget request for 2014-15, where
it could have been debated by legislators. Instead, lawmakers not only stripped it from the budget,
but inserted language that would have barred Medicaid expansion without the approval of the
legislature. Kasich used a well-placed veto to remove that provision and keep his options open.

Lawmakers had months to consider alternatives, including an expansion bill that included some of
the checks and balances Republicans said they wanted. Bills languished in both the House and
Senate.

Only as time was running out for a plan to be developed and in place by the Jan. 1 start date
did Kasich turn to the Controlling Board, whose function is to authorize the spending of money that
doesn’t come from the General Revenue Fund. He did so after securing the federal government’s
approval for the expansion.

Undeterred by obstacles, Kasich stuck it out and achieved the right result.